what happens after denial

joyj
on 10/10/06 1:27 am - Middle Island, NY

If you go through the insurance process and are denied then appeal and all appeals are denied can you reapply for the surgery at a later date?  I'm not there yet but am wondering what happens at that point. Thanks

Sarahlicious
on 10/10/06 7:43 am - Portsmouth, OH
I'm going to guess and say yes you can if the situation has changed...take for example. You get denied based on the fact you do not have proper documentation of 6 months diet...but you got weighed every month for 6 months. So you appeal and try and fight it...while in the mean time continue to see your doc and make sure he takes additional notes. So appeals process #1 goes to #2 and finally a complete exhauted appeals proccess and still denied. But now you have 4 more months of the new 6 months detailed documented supervised diet...so 2 more months later your surgeon submits a new claim with the new documented diet and you should be considered and hopefully approved!

I have Lipedema and Lymphedema. I also have a passion for Obesity and Health Insurance Advocacy

Blog: born2lbfat.com Facebook: Born2lbFat Twitter: @born2lbfat

joyj
on 10/10/06 11:51 am - Middle Island, NY

I actually have all the documentation, the insurance co keeps saying they are missing something--which is frustrating because they could be saying that with the paper right in front of them.  I guess what I was trying to ask is if you are denied and appeals fail, could you re-submit or is it just over? Truly frustrating which is probably their goal but I will keep after them. Thanks

Sarahlicious
on 10/10/06 12:13 pm - Portsmouth, OH
Well of course nothing stops you from resubmitting, however unless something is different nothing stops them from just denying again and maybe this time having justification for denying further appeals. I would suggest if they they deny and you have to do a second appeal get your own copy of all documents and send them together certified mail, return receipt...then call everyday and make sure every page gets into their system.

I have Lipedema and Lymphedema. I also have a passion for Obesity and Health Insurance Advocacy

Blog: born2lbfat.com Facebook: Born2lbFat Twitter: @born2lbfat

Sean_B
on 10/10/06 12:32 pm - Schenectady, NY
I could be wrong, but the way I understand it.... from what you're posting, you were denied because they were missing something.... you're not appealing, you're just giving them what they're missing good luck

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